Friday, February 22, 2008

Neanderthals and Little League Shoulder

Americans are crazy about sports- witness that thirty million more people watched the most recent Super Bowl than the first Bush-Kerry presidential debate. I am ashamed to admit that I was one of the reprehensible Neanderthals that skipped the debate and ate pizza and drank beer through the Super Bowl.

This craze afflicts our youth as well, with surging injury rates in child athletes. We are seeing more and more acute and overuse joint injuries. Here is a 13 year-old male pitcher, who complained of pain while throwing. He was tender over the proximal humerus. (A) Coronal proton-density and (B) T2-weighted images show widening of the lateral humeral physis.

This injury is known by the eponym "Little Leaguer's shoulder", and is typically seen in the young teenage baseball player. It represents a stress-related injury to the growth plate. This injury is typically diagnosed using conventional radiographs, but one can occasionally run across it on MRI. Associated x-ray findings include sclerosis of the proximal humeral metaphysis and fragmentation of the lateral aspect of the proximal humeral metaphysis. It is treated conservatively, with several weeks of rest, and the majority of patients return to their athletic activity.

Pediatric musculoskeletal MRI can be challenging- one has to contend with the variable appearance of the skeleton through development (CRITOE, anyone?), and different diseases strike the pediatric population. I recently ran across an excellent book by J. Herman Kan and Paul Kleinman, devoted to pediatric musculoskeletal MRI. The pictures are of high quality, and the accompanying text is also excellent. Very much worth reading- nobody wants to miss an important diagnosis in a child.

Vic David MD

1 comment:

Anonymous said...

Great articles, Thanks

1. The words "Metatarsal" Sounds and from the point grammer is an adjective. Probably the noun of 'Bone' should follow metatarsal, since its origin is as "Ossa Metatarsalis".

2. Adding normal to pathologic findings is great help.